Importance of Dietary Sources of Iron in Infants and Toddlers: Lessons from the FITS Study
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Sample Characteristics
3.2. Contribution of Infant Cereal to Diet
3.3. Meat Consumption
3.4. Iron Intakes: Infant Cereal Users and Non-Users
3.5. Energy Intakes: Infant Cereal Users and Non-Users
4. Discussion
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
- Centers for Diseaes Control and Prevention (CDC). Iron deficiency—United States, 1999–2000. MMWR Morb. Mortal. Wkly. Rep. 2002, 51, 897–899. [Google Scholar]
- United States Department of Health and Human Services. Healthy People 2020 Nutrition and Weight Status Objectives. 2010. Available online: https://www.healthypeople.gov/ (accessed on 1 May 2017).
- Baker, R.D.; Greer, F.R. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0–3 years of age). Pediatrics 2010, 126, 1040–1050. [Google Scholar] [CrossRef] [PubMed]
- Lozoff, B.; Kaciroti, N.; Walter, T. Iron deficiency in infancy: Applying a physiologic framework for prediction. Am. J. Clin. Nutr. 2006, 84, 1412–1421. [Google Scholar] [PubMed]
- Radlowski, E.C.; Johnson, R.W. Perinatal iron deficiency and neurocognitive development. Front. Hum. Neurosci. 2013, 7, 585. [Google Scholar] [CrossRef] [PubMed]
- Lozoff, B.; Beard, J.; Connor, J.; Barbara, F.; Georgieff, M.; Schallert, T. Long-lasting neural and behavioral effects of iron deficiency in infancy. Nutr. Rev. 2006, 64, S34–S43. [Google Scholar] [CrossRef] [PubMed]
- Lozoff, B.; Castillo, M.; Clark, K.M.; Smith, J.B. Iron-fortified vs. low-iron infant formula: Developmental outcome at 10 years. Arch. Pediatr. Adolesc. Med. 2012, 166, 208–215. [Google Scholar] [CrossRef] [PubMed]
- Lozoff, B.; Smith, J.B.; Kaciroti, N.; Clark, K.M.; Guevara, S.; Jimenez, E. Functional significance of early-life iron deficiency: Outcomes at 25 years. J. Pediatr. 2013, 163, 1260–1266. [Google Scholar] [CrossRef] [PubMed]
- Lozoff, B.; Castillo, M.; Clark, K.M.; Smith, J.B.; Sturza, J. Iron supplementation in infancy contributes to more adaptive behavior at 10 years of age. J. Nutr. 2014, 144, 838–845. [Google Scholar] [CrossRef] [PubMed]
- Gupta, P.M.; Perrine, C.G.; Mei, Z.; Scanlon, K.S. Iron, Anemia, and Iron Deficiency Anemia among Young Children in the United States. Nutrients 2016, 8, 330. [Google Scholar] [CrossRef] [PubMed]
- Lopez, A.; Cacoub, P.; Macdougall, I.C.; Peyrin-Biroulet, L. Iron deficiency anaemia. Lancet 2016, 387, 907–916. [Google Scholar] [CrossRef]
- Ziegler, E.E. Consumption of cow’s milk as a cause of iron deficiency in infants and toddlers. Nutr. Rev. 2011, 69 (Suppl. 1), S37–S42. [Google Scholar] [CrossRef] [PubMed]
- Gibson, R.S.; Heath, A.L.; Szymlek-Gay, E.A. Is iron and zinc nutrition a concern for vegetarian infants and young children in industrialized countries? Am. J. Clin. Nutr. 2014, 100 (Suppl. 1), 459S–468S. [Google Scholar] [CrossRef] [PubMed]
- American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics 2012, 129, e827–e841. [Google Scholar]
- Siega-Riz, A.M.; Deming, D.M.; Reidy, K.C.; Fox, M.K.; Condon, E.; Briefel, R.R. Food consumption patterns of infants and toddlers: Where are we now? J. Am. Diet. Assoc. 2010, 110 (Suppl. 12), S38–S51. [Google Scholar] [CrossRef] [PubMed]
- American Academy of Pediatrics Committee on Nutrition. Pediatric Nutrition, 7th ed.; American Academy of Pediatrics: Elk Grove Village, IL, USA, 2014. [Google Scholar]
- Domellof, M.; Braegger, C.; Campoy, C.; Colomb, V.; Decsi, T.; Fewtrell, M.; Hojsak, I.; Mihatsch, W.; Molgaard, C.; Shamir, R.; et al. Iron requirements of infants and toddlers. J. Pediatr. Gastroenterol. Nutr. 2014, 58, 119–129. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. Infant and Young Child Feeding. 2009. Available online: http://www.who.int/nutrition/publications/infantfeeding/9789241597494/en/ (accessed on 1 May 2017).
- Fewtrell, M.; Bronsky, J.; Campoy, C.; Domellof, M.; Embleton, N.; Fidler, M.N.; Hojsak, I.; Hulst, J.M.; Indrio, F.; Lapillonne, A.; et al. Complementary Feeding: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. J. Pediatr. Gastroenterol. Nutr. 2017, 64, 119–132. [Google Scholar] [CrossRef] [PubMed]
- McCarthy, P.J.; Zundel, H.R.; Johnson, K.R.; Blohowiak, S.E.; Kling, P.J. Impact of Growth Restriction and Other Prenatal Risk Factors on Cord Blood Iron Status in Prematurity. J. Pediatr. Hematol. Oncol. 2016, 38, 210–215. [Google Scholar] [CrossRef] [PubMed]
- Ziegler, E.E.; Nelson, S.E.; Jeter, J.M. Iron stores of breastfed infants during the first year of life. Nutrients 2014, 6, 2023–2034. [Google Scholar] [CrossRef] [PubMed]
- Clayton, H.B.; Li, R.; Perrine, C.G.; Scanlon, K.S. Prevalence and reasons for introducing infants early to solid foods: Variations by milk feeding type. Pediatrics 2013, 131, e1108–e1114. [Google Scholar] [CrossRef] [PubMed]
- Dee, D.L.; Sharma, A.J.; Cogswell, M.E.; Grummer-Strawn, L.M.; Fein, S.B.; Scanlon, K.S. Sources of supplemental iron among breastfed infants during the first year of life. Pediatrics 2008, 122 (Suppl. 2), S98–S104. [Google Scholar] [CrossRef] [PubMed]
- Hamner, H.C.; Perrine, C.G.; Scanlon, K.S. Usual Intake of Key Minerals among Children in the Second Year of Life, NHANES 2003–2012. Nutrients 2016, 8, 468. [Google Scholar] [CrossRef] [PubMed]
- Grimes, C.A.; Szymlek-Gay, E.A.; Campbell, K.J.; Nicklas, T.A. Food Sources of Total Energy and Nutrients among U.S. Infants and Toddlers: National Health and Nutrition Examination Survey 2005–2012. Nutrients 2015, 7, 6797–6836. [Google Scholar] [CrossRef] [PubMed]
- Krebs, N.F.; Sherlock, L.G.; Westcott, J.; Culbertson, D.; Hambidge, K.M.; Feazel, L.M.; Robertson, C.E.; Frank, D.N. Effects of different complementary feeding regimens on iron status and enteric microbiota in breastfed infants. J. Pediatr. 2013, 163, 416–423. [Google Scholar] [CrossRef] [PubMed]
- Briefel, R.R.; Kalb, L.M.; Condon, E.; Deming, D.M.; Clusen, N.A.; Fox, M.K.; Harnack, L.; Gemmill, E.; Stevens, M.; Reidy, K.C. The Feeding Infants and Toddlers Study 2008: Study design and methods. J. Am. Diet. Assoc. 2010, 110 (Suppl. 12), S16–S26. [Google Scholar] [CrossRef] [PubMed]
- Devaney, B.; Kalb, L.; Briefel, R.; Zavitsky-Novak, T.; Clusen, N.; Ziegler, P. Feeding infants and toddlers study: Overview of the study design. J. Am. Diet. Assoc. 2004, 104 (Suppl. 1), s8–s13. [Google Scholar] [CrossRef] [PubMed]
- Institute of Medicine; Food and Nutrition Board. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids; National Academy of Press: Washington, DC, USA, 2005. [Google Scholar]
- Brown, A.; Jones, S.W.; Rowan, H. Baby-Led Weaning: The Evidence to Date. Curr. Nutr. Rep. 2017, 6, 148–156. [Google Scholar] [CrossRef] [PubMed]
- Nicklaus, S. The Role of Dietary Experience in the Development of Eating Behavior during the First Years of Life. Ann. Nutr. Metab. 2017, 70, 241–245. [Google Scholar] [CrossRef] [PubMed]
- Wang, J.; Wu, Y.; Xiong, G.; Chao, T.; Jin, Q.; Liu, R.; Hao, L.; Wei, S.; Yang, N.; Yang, X. Introduction of complementary feeding before 4 months of age increases the risk of childhood overweight or obesity: A meta-analysis of prospective cohort studies. Nutr. Res. 2016, 36, 759–770. [Google Scholar] [CrossRef] [PubMed]
- Friel, J.K. There Is No Iron in Human Milk. J. Pediatr. Gastroenterol. Nutr. 2017, 64, 339–340. [Google Scholar] [CrossRef] [PubMed]
- Krebs, N.F.; Westcott, J.E.; Culbertson, D.L.; Sian, L.; Miller, L.V.; Hambidge, K.M. Comparison of complementary feeding strategies to meet zinc requirements of older breastfed infants. Am. J. Clin. Nutr. 2012, 96, 30–35. [Google Scholar] [CrossRef] [PubMed]
- Cox, K.A.; Parkin, P.C.; Anderson, L.N.; Chen, Y.; Birken, C.S.; Maguire, J.L.; Macarthur, C.; Borkhoff, C.M.; TARGet Kids! Collaboration. Association Between Meat and Meat-Alternative Consumption and Iron Stores in Early Childhood. Acad. Pediatr. 2016, 16, 783–791. [Google Scholar] [CrossRef] [PubMed]
- Akkermans, M.D.; Eussen, S.R.; van der Horst-Graat, J.M.; van Elburg, R.M.; van Goudoever, J.B.; Brus, F. A micronutrient-fortified young-child formula improves the iron and vitamin D status of healthy young European children: A randomized, double-blind controlled trial. Am. J. Clin. Nutr. 2017, 105, 391–399. [Google Scholar] [CrossRef] [PubMed]
Variable | 6–8.9 Months | 9–11.9 Months | 12–17.9 Months | |||
---|---|---|---|---|---|---|
Percentage (SE) | Cereal User n = 186 | Non-User n = 63 | Cereal User n = 155 | Non-User n = 101 | Cereal User n = 73 | Non-User n = 421 |
Child’s Sex Male | 54.42 (6.16) | 71.91 (8.02) | 50.02 (6.56) | 49.32 (8.03) | 53.14 (9.39) | 47.91 (3.83) |
First Born | 38.07 (6.40) | 19.44 (6.52) | 37.32 (6.58) | 20.93 (5.88) | 50.71 (10.07) | 32.23 (3.62) |
Race/Ethnicity | ||||||
Non-Hispanic White | 46.36 (4.58) | 53.53 (7.03) | 53.95 (4.56) | 47.88 (5.45) | 48.40 (6.79) | 55.23 (3.11) |
Non-Hispanic Black | 15.57 (2.79 | 10.57 (6.41) | 12.21 (2.62) | 18.29 (5.38) | 8.13 (3.56) | 14.25 (1.96) |
Hispanic | 32.37 (5.49) | 20.09 (5.83) | 26.46 (5.87) | 22.43 (4.38) | 36.72 (8.16) | 22.94 (2.82) |
Other | 5.71 (1.28) | 15.81 (3.62) | 7.38 (3.14) | 11.40 (3.19) | 6.74 (2.45) | 7.59 (1.76) |
Child Receives WIC | 46.98 (6.03) | 38.05 (9.48) | 50.34 (7.66) | 34.73 (5.21) | 32.45 (3.56) | 47.41 (9.73) |
Attends Child Care | 46.27 (6.42) | 32.27 (8.30) | 34.73 (5.21) | 42.20 (7.92) | 47.41 (9.73) | 48.75 (3.86) |
Mother Works | 54.00 (6.89) | 30.73 (7.20) | 47.72 (6.79) | 61.26 (8.11) | 52.38 (9.18) | 51.84 (4.09) |
Currently Breastfeeding | 44.83 (7.95) | 64.36 (8.79) | 36.44 (7.40) | 53.49 (8.60) | 14.96 (5.95) | 12.81 (2.33) |
Ever Breastfed | 74.49 (4.86) | 76.53 (7.77) | 88.26 (3.11) | 78.06 (6.21) | 84.31 (5.29 | 77.73 (2.96) |
Received Formula * | 79.25 | 56.47 | 74.27 | 52.42 | 31.14 | 13.03 |
4–5.9 Months | 6–8.9 Months | 9–11.9 Months | ||||||
---|---|---|---|---|---|---|---|---|
Food Group | % Total Iron Intake | SE | Food Group | % Total Iron Intake | SE | Food Group | % Total Iron Intake | SE |
Infant formula | 60.0 | 3.1 | Infant Cereal | 47.9 | 3.0 | Infant Cereal | 35.3 | 3.4 |
Infant cereal | 36.4 | 3.2 | Infant Formula | 41.9 | 2.6 | Infant Formula | 33.7 | 2.4 |
Vitamin/mineral supplements | 1.2 | 0.8 | Vitamin/Mineral Supplements | 1.4 | 0.8 | Non-Infant Cereals | 8.1 | 1.8 |
Non-Infant Cereal | 1.3 | 0.4 | Vitamin/Mineral Supplements | 4.7 | 2.1 | |||
Crackers/Pretzels/Rice Cakes | 1.2 | 0.3 | Crackers/Pretzels/Rice Cakes | 1.7 | 0.3 | |||
Beef | 1.7 | 1.1 | ||||||
100% Juice | 1.2 | 0.2 | ||||||
Pasta | 1.0 | 0.3 | ||||||
Baby Food Dinners | 1.0 | 0.2 |
© 2017 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Finn, K.; Callen, C.; Bhatia, J.; Reidy, K.; Bechard, L.J.; Carvalho, R. Importance of Dietary Sources of Iron in Infants and Toddlers: Lessons from the FITS Study. Nutrients 2017, 9, 733. https://doi.org/10.3390/nu9070733
Finn K, Callen C, Bhatia J, Reidy K, Bechard LJ, Carvalho R. Importance of Dietary Sources of Iron in Infants and Toddlers: Lessons from the FITS Study. Nutrients. 2017; 9(7):733. https://doi.org/10.3390/nu9070733
Chicago/Turabian StyleFinn, Kristen, Cheryl Callen, Jatinder Bhatia, Kathleen Reidy, Lori J. Bechard, and Ryan Carvalho. 2017. "Importance of Dietary Sources of Iron in Infants and Toddlers: Lessons from the FITS Study" Nutrients 9, no. 7: 733. https://doi.org/10.3390/nu9070733